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Permit CITY OF TIGARD ELECTRICAL PERMIT PER ELC2008 -00350 °.. COMMUNITY DEVELOPMENT DATE ISSUED: MIT #: 6/19/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 134BD -07202 SITE ADDRESS: 10900 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: TRINITY EVANGELICAL Project Description: Installing (1) service and (1) branch circuit for sound system. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: TRINITY CHURCH OF THE MIKE'S ELECTRIC EVANGELICAL CHURCH OF NORTH 11070 SW ALLEN BLVD AMERICA • BEAVERTON, OR 97005 TIGARD, OR 97223 Phone: Contact #: PRI 503 - 649 -6991 FAX 503 - 641 -1902 FEES Description Date Amount Reg #: ELE 34 -18c [ELPRMT] ELC Permit 6/19/2008 $86.95 LIC 50209 [TAX] 12% State Surchar 6/19/2008 $10.43 SUP 42305 Total $97.38 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: - -�� -• Permittee Signature: c "// '. 4 // OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Sent By: MIKE'S ELECTRIC; 591 7847; Jun -18 -08 14:24; Page 1/2 T0 TIGARD At : ,5035981960 • Electrical Permit A heath) ECEIVE 1:OR OFI''{t is (at '�,''' City of Tigard 1 $'2�0$ oatek i7 a P'""" eP'""" 141'' ; /,. Pa u S• = 1� " 23125 5W Hall 9ivd„ SUN Tigard, OR 97323 Plan Review Phone': 503 639 417l Fax: 503,59R.196U Det t1B Other t >acmit: OF TIGA -- 1lUA„� CITY OF l : ' r `' ,nfi ed/fv1e11, d roar: P Page 2fur n vI see Supplemented Iemenlal Information htspcctian Line: 503.639.4175 Date Read /$ ' Internet: www.tigard- or.gnv, S li � � - Please check all that apply (submit 2. Sets of plans w /items checked below). Eli New construction ❑ Addition/alteration/replacement O 5ervtce of feeder 400 amps Of more ❑ Building over three stories. CJ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards. 64 fido12Y: tbke ' kirc"> itik : .;;r ; I , . ', '::. ?.. .,, : ,,,: r . �: '. exceeds 10.000 amps at 150 volts v+ g buildings. "� � °' tloatin buildm leas n, ground, or exceeds 14,000 ❑ Commercial -ase a ❑ I- and2.tamily. dwelling {$J Commercial /industrial Li Accessory building i mp. toruti oilier installations , buildings © Multi-family El Master builder Other: ❑ Fire pump 0 Installation of 75 KV1v or II 1 t Ju , , , ,,,, , ,; ,,, ❑Emergency syslarr+. target separately derived system. . AA S1`CE �MNF( BMA4<•Irt 1 •r , X,.t " ; I` 'r° ■a ❑Addison of new motor load of ❑ "A" "li" "I - 2' "' I - „ Joh no.: 25323 Job site address: 10900 SW 121st Ave. t ixor or more. Recreational ❑ Six or more residential unite. ❑ Recreationn al vehicle parks. Lib /Stnls % %l lr: Tigard 97223 ID Hr'atth - rare facilities. ❑ Supply voltage for more than s © Hazardous locations 600 volts nominal. Suite /bldg. /apt. no.: Project name: (, I/�, r � ^ © SCIV i et Or f eeder 600 amps or more. ...., —,.. lI t I -j 6v ^ �/ lam' ;::;!.',1 ^i2;:,,. .,11 ::11',11': '. ',:.:: .. .. • i . I - _...."._ I Qtym llµF dwetlin Cross 5trectklirectlons to . job silt.: n; tlen i , , e e . 1 Telal " ' • New residential single- or multi- 11+m0y dwelling unit. Includes attached garage. - T Subdivision; Lot no.; 1,000 sq. ft. or less 145.15 4 - - •" - -- • Ea. udd'1500 sq, ft, or portion 33.40 i Tllx map/parcel no,: Litllited energy, residential --,. - - 7500 ^� 1)FSC Rrrrra .::'l r : (with c sq. ft. �. -.� .,. ith abo� - Limited energy, multi - family - 75.00 2 Panel. change and sounds e circuit residential t above so. e.) ' Services or Feeders installation, alteration, and /or relocation 200 amps or less 1 80.30 . 1 1 2 „ .. . `C] ' TENANT • ❑ PROPERTY OWNER , . , . � , •! + : " • 701 amps to 400 amps 106.85 MEE 2 Name: Trinity Evangelical Church 401 amps to 600 amps = 160.60 111 2 601 amps to 1,000 amps ill 240.60 2 Address: 10900 SW 121st Ave. Over 1 "000 amps or volts 454.65 2 City /State /7_IP: Temporary services or feeders Installation, alteration, and /or Tigard, OR 97223 relocation 1) ( 503 ) 804.8272 Fax: ( ) 200 amps or less 66,85 1 201 amps to 400 amps 100.30 2 Owner Installation: This installation is being mode on property that I own which is not _ - , irticllded for sale. lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits- new, alteration, or extension, per panel Owner Signature: _ - Date: A. Fee for branch circuits with _ ..: ;..; AFRLTCAI'V �.,. � x , -„ � r ': .' shave service or feeder fa, �" i�' �i 1: � , � ,l, „,,,” 6.65 �+(� 2 - each branch circuit 1, � Business rlafile: B. Fee for branch cncllitn "' without service or feeder tee, 46.85 2 Contact name: first branch circuit Address: Each KIWI branch circuit _ .. - 2 - Miscellaneous (service or feeder not included) City /State /ZIP; Each manufactured Or modular 90.90 2 Phone: ( ) tax:: ( ) dwelling, service and /or feeder _ _Reconnectonly 66,85 2 ,:-mail; _ Pump or irrigation circle — 53.40 2 G+�rNT iI ` ;; ' ,, + + Sign or outline lighting 53,40 2 Business name: JD Miller Construction DIBA Mike's Electric Signal circuit(s) or limited- . energy panel, alteration, or - Address: 11070 SW Allan Blvd. extension. Describe; Page 2 2 CI(v /State/ZiP Beaverton, QR 97005 Each Additional inspection over allowable in an1of the above -- • Per inspection 62.50 Phone; (5031 649.6991 Fax: (503) 641 -1902 Investigation per hour (1 hr min) 62.50 CC Lic.: 050209 Electrical Tie.: 34 -18C Suprv, Lie.: 4230S industrial plant pe hour t 73.75 > .,. ..,.•._ '�.': A ^.,,!Ni,'4:; ni nix'.'.,. {' .7r 0)* '. M1 :�i y rk0:,:. .. Suprv. Electrician signature. required: _ Subtotal: 86.9.5 Print name: Douglas J, Miller i Date: 06.18.08 ._ Plan review (25% of permit fee): _ —. _..._.... — Slate surcharge (12% of permit fee): 10.43 - Authorized signaiW r..r /.d. A TOTAL PERMIT FEE: 97.38 r�a This permit application expires if a permit is not obtained within 140 11I'1211 name: - days after it has been accepted as complete. - ....T • Number of inspections allowed pei par toil. 11RondinK ,Permmm..t••PermitApp.doc OSrdt /oe 440 -461s r( ii los /COMAWEB CITY OF TIGARD A ,. BUILDING DIVISION 1 PERMIT #: ELC2000 -003 &0 13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 61/9/21)09 Phone: (503) 639 -4171 y 4 � � �� ; � it + l , Inspection Requests (24 Hrs.): (503) 639 - 4175!x/► INSPECTION WORKSHEET FOR DATE: 7/16/2008 TIME: 7 :00AM PAGE: 36 SITE ADDRESS: 10900 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: TRINITY EVANGELICAL DESCRIPTION: Installing (1) service and (1) branch circuit for sound system. OWNER: TRINITY CHURCH OF THE, PHONE #: CONTRACTOR: MIKE'S ELECTRIC PHONE #: 503-649 -6991 Inspection Request Scheduled For: Date: 7/16/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 072710 -01 so-ma-6991 Y '1OL S2 - 72, Corrections /Comments /Instructions: OR v ci Ail/l \\ \.( --- N. \ u 1.1`i1 PAS n PARTIAL APPROVAL El CANCEL ,_ NO ACCESS \ ❑ F. ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G V 6 L. --- M Date: 1 ' 140 ' O Phone #: (503) 718- 2 4TO